Date

MM

DD

YYYY

Parent/Guardian Name One *

First Name

Last Name

Phone *

(###)

###

####

Parent/Guardian Name Two

First Name

Last Name

Phone Of Parent/Guardian 2

(###)

###

####

Child's Name 1 *

First Name

Last Name

Birthday

MM

DD

YYYY

Child's Name 2

First Name

Last Name

Birthday Child 2

MM

DD

YYYY

Child's Name 3

First Name

Last Name

Birthday Child 3

MM

DD

YYYY

Registration Agreement

I, the undersigned, being the parent or guardian of the above-named boy/girl, a member of the HIGH SCHOOL YOUTH GROUP of Restore, do hereby consent to the participation of my son/daughter in all activities connected to the program during and beyond regular meeting hours, at the Church or beyond the Church grounds, providing such activities are supervised by the counselor. This consent will include all outings, events, and activities sponsored by the HIGH SCHOOL YOUTH GROUP as well. I give my consent for my child to be transported to off-site events sponsored by the HIGH SCHOOL YOUTH GROUP by an approved driver, as needed. I understand that if I DO NOT consent it will be my responsibility to drive my son/daughter to these events. I release the counselors and the Church of the club from all liability in case of accident or injury during all meetings, activities, and events of the club. Recognizing that accidents do happen, I also authorize the HIGH SCHOOL YOUTH GROUP counselors to take whatever medical action they believe to be in my son/daughter’s best interests should the need arise and that all efforts will be made to contact me or the designated emergency contact as soon as possible. The counselors promise to ensure safety and supervision.


I agree

I DO NOT agree